Inspection on 07/11/07 for Appletree Grange

This inspection was carried out on 7th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Appletree Grange 01/10/09

Appletree Grange 21/09/06

Appletree Grange 09/11/05

Appletree Grange 21/06/05

Appletree Grange 17/12/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Appletree Grange Durham Road Birtley County Durham DH3 2BH Lead Inspector Miss Andrea Goodall Key Unannounced Inspection 10:00a 7 & 12th November 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appletree Grange Address Durham Road Birtley County Durham DH3 2BH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0191 4102175 0191 4102433 appletree@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited Applicant Manager – Elizabeth Brown Care Home 32 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (32), Physical disability over 65 years of age (8), Sensory Impairment over 65 years of age (1) Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st September 2006 Brief Description of the Service: Appletree Grange is registered to provide personal care for 32 older people, some of whom may have dementia care needs, physical disability or a sensory impairment. The home is not registered to provide nursing care, but district nursing services are arranged where necessary. All bedrooms are single and have en-suite facilities. The home provides some aids and adaptations to support the needs of people with physical disabilities. The layout and the design of the building ensure easy access to WC’s and a choice of lounge areas for the people who live here. There is a lift to take people to and from the first floor. To the front of the building is a sheltered garden seating area for use by residents and their relatives. A car park is sited to the rear of the home and provides ample parking for visitors. The main access into the building is via a short ramp at the rear entrance. The home is situated in Birtley on the main Durham Road. It is on a bus route and is close to local shops and other local amenities. The weekly fees range from £372:86 (local authority funded) to £425 (privately funded). Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the visit: We looked at: • information we have received since the last visit on 21st September 2006 • how the service dealt with any complaints & concerns since the last visit • any changes to how the home is run • the provider’s view of how well they care for people • the views of people who use the service & their relatives. We received 18 surveys from residents and 12 surveys from relatives. The Visit: An unannounced visit was made on date 7th November 2007. Another visit was made on 12th November 2007. During the visit we: • talked with people who use the service, relatives, staff, the manager & visitors • joined residents for two meals and looked at how staff support the people who live here • looked at information about the people who use the service & how well their needs are met • looked at other records which must be kept • checked that staff had the knowledge, skills & training to meet the needs of the people they care for • looked around parts of the building to make sure it was clean, safe & comfortable • checked what improvements had been made since the last visit. We told the manager what we found at each visit. What the service does well: All residents have good information about the home in a welcome pack in their bedrooms. One person said, “I received plenty of information so I knew this was the right home for me.” Each resident’s needs and wished are set out in a clear care plan that show staff exactly how to help them. The home supports people to have good access to any health care that they need. Relatives said that they are always kept informed of the residents’ health. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 6 The people who live here said that they are treated with respect and dignity. One resident said, “The staff are very good and polite.” One relative also commented, “I find all the staff very helpful and exceptionally caring towards the residents.” The home provides a good range of activities, social events and outings. Residents and visitors said that the home is “very cheerful”, “very homely” “ and “always a pleasant atmosphere”. Everyone said that the meals are “excellent!” The home has a good standard of decoration and furnishings. It is warm, comfortable, ‘homely’ and very clean. The people who live here said many good things about staff. They said, “staff are always there when I need them” and “all the staff are nice”. Staff said they have good training. The recent change to management was well planned so that the home continues to be well run. What has improved since the last inspection? What they could do better: Residents have good information about the service, but it might be better if they had information about the range of fees before they move in. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 7 The medication cupboard should be changed to a metal, alarmed cupboard. Also, staff must always remember to lock the medication trolley when it is out of their sight. All new staff must have a police check before they start work, unless there are special circumstances that have been agreed with the CSCI. Night staff must have in-house training at the right periods to show that they are regularly reminded of the fire procedures. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. (NMS 6 does not apply to this service.) People who use this service experience good quality outcomes in this area. People receive sufficient information about the service to help them make an informed decision about whether to move here, and good assessment processes ensure that potential residents’ needs can be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home provides a clear information about its service in a Statement of Purpose and a Service Users Guide, which are in the reception area. This information is also summarised in an easy-to-read Welcome Pack in every bedroom. This means that all residents have their own copy to refer to Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 10 whenever they want. The pack includes the complaints procedure, mealtimes, fire procedures and other general information about the home. One newer resident described the welcome pack as “very useful”. Before any resident moves to the home they are assessed by a care manager of the Social Services Department, and also by senior staff of Springvale Court. The home uses both the social work reports and it’s own assessment processes to ensure that the full details of a potential resident’s needs are obtained before their admission. There were also clear examples where the home’ assessment showed that it could not meet a person’s needs. This means that only people whose needs can be met are admitted to the home. The assessment records that were sampled also included details of each resident’s background, life history, and cultural and spiritual needs. In this way the home aims to support people’s diversity of social care needs. Wherever possible, residents and their relatives are encouraged to come and have a look around the home prior to their move here. Some residents had previously stayed at other homes and said that this one was “much better”. Comments in the residents’ surveys included : “I had a look around before I came to Appletree.” “It was my choice to come into this home.” “I received plenty of information so I knew this was the right home for me.” Most residents feel that they had received lots of information about the service both before and after they moved here. A couple of weeks after they move in, residents are given a blank copy of the Residents’ Contract which outlines the terms and conditions of their residence. This gives them time to read it before their six-week review. However this does not include the level of fees so residents may not always have this information until the six-week review. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. Residents have very good support with personal care and good access to health care services, which ensures that their needs are met. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: After a resident has moved to the home a care plan is designed around their assessed needs so that staff know how to provide the right support. It was evident that a lot of work has been put into care plans since the last inspection, and these are now of a very good standard. Care plans sampled were very detailed, easy to follow, and outlined each resident’s needs and how these should be supported. In this way staff can be very clear about exactly how to assist people with their individual needs. It is Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 12 good practice that the care plans also outline the tasks that residents can manage for themselves so that their independence is upheld. For example, some people need physical assistance with dressing, but care plans show staff whether they are still able to choose their own clothes and whether they are still be able to manage buttons or zips. In this way residents can continue to be as fully involved in their own care as possible. Of several care plans examined, there was only one example where a resident’s specific behavioural needs did not include guidelines for all staff to follow. In this way different staff may have been providing a different response to the person’s needs, which would be confusing for the resident. (This was addressed immediately during the visit.) Care plans are reviewed at least monthly and any change in need or support is updated. Of the sample examined, only one risk assessment had not been updated following a change in circumstance (e.g. following a fall by a resident) although the support had changed correctly. The home ensures that all residents are registered with appropriate community health care services, including GP, dental, ophthalmic and chiropody services. The manager confirmed that the home continues to have very good contact with local GP surgeries and district nursing services. Care files contained clear assessments to monitor residents’ well-being, for example with mobility, and nutrition. There were some very good instances of how the assessment and care planning processes has led to improvements for residents. For example, a resident’s improved speech following referral and input from speech therapists. In surveys, several relatives made positive comments about how the home supports people with their health care needs, including: -“Since my mother entered the home I have noticed an improvement in her health and well-being.” - “I have always been informed of hospital visits or anything that may lead to my mother needing a doctor.” -“There is good contact from the home, especially during illness.” Nutritional assessments have improved to show supplementary diets and the input of dieticians. There are also very clear moving & assisting assessment to show what support each resident needs with getting around. At this time the home only has one hoist. There are only a small number of residents who need this equipment, but they are accommodated on different floors so the hoist has to be transported in the lift. Staff felt that this was manageable at this time, and the manager has also contacted physiotherapy service for advice about alternative equipment. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 13 There are self-administration assessments to show whether people can manage their own medication. At this time most people have who could manage their own medication have requested that staff do this for them. However one person had not kept hold of their angina medication for when they go out. (This was addressed during this visit.) Senior staff are responsible for the administration of medication, and they are provided with training in the safe handling of medicines. The administration of medication was carried out correctly. Medication is transported around the home in a secure medication trolley. However during this visit there were occasions when the medication trolley was left open in the hallway whilst staff took medication into a lounge for residents. This compromised the security of residents’ medication. At all other time the medication is stored in a locked medication room. The medication cupboard in this room is also lockable but is not very robust, and controlled drugs are being stored in an inappropriate box. (By the end of this visit a new metal medication cupboard had been ordered.) During discussions, residents indicated that they feel that they are treated with respect and dignity within the home. One resident said, “The staff are very good and polite.” One relative also commented, “I find all the staff very helpful and exceptionally caring towards the residents.” It was clear from discussions with residents and visitors that people are sensitively supported with their personal grooming and appearance. One visitor said, “Mum is always well looked after, and they keep her clean and well dressed.” A weekly hairdressing service is available at the home, which several residents enjoy. Residents can use their own bedrooms for privacy whenever they wish. Newer residents confirmed that they were given a key to their bedrooms as soon as they moved in. One relative said, “I am happy that if my mother wishes to stay in her own room, that’s ok.” Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience excellent quality outcomes in this area. Residents have very good opportunities to make choices about social activities, daily routines and menus so that they lead a lifestyle that matches their individual preferences. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: It is good practice that the home’s assessment and care planning also includes people’s individual social, religious and lifestyle needs. For example, residents who have different faiths are supported to continue to practice these and menus choices take into account their religious beliefs. In this way people can continue to follow their own preferred lifestyles. The home employs a part-time activities co-ordinator who organises activities on three days a week. Care staff also provide lots of activities for residents. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 15 People described several daily activities they take part in, if they choose, including ball games, dominoes, watching videos, cards and singalongs. They also described trips out, especially to the coast for fish and chips. One relative felt that there could be “a little more crafts and skill work to stimulate the mind.” In discussions the manager commented that she plans to develop more activity for people with dementia care needs Some residents also enjoy lots of community contact, such as using the community centre (which is opposite the home) for weekly tea dances and bingo afternoons. Some people enjoy walks around the local garden centre. It is good practice that a male care staff supports the male residents to use the pub next door to watching football on the big screen television there. Relatives felt that entertainment and outings were regularly arranged. One relative said, “The staff have made a lot of effort to establish her likes and dislikes. Her abilities are limited but she has been given some simple tasks to do in an effort to stimulate her mind.” There was a steady stream of visitors to the home during these visits. The visitors said that they are always made to feel welcome, and described the home as “very cheerful”, “very homely” “happy environment”, “always a pleasant atmosphere”. Relatives confirmed that they are always invited to social events at the home. Many residents described how they had enjoyed a recent themed day (as part of a Barchester competition). All the staff dressed as characters from Oliver Twist, a talented relative told and sang the story of Oliver Twist, and a special lunch menu was presented to all residents, relatives and other invited guests. The home has since been nominated for a local award for this special event. All residents who took part in discussions described the quality of meals as “excellent”. There are colourful written menus in both of the pleasant dining rooms that show that day’s menu choices. It is very good practice that residents are also asked which dish they would like at the time of the actual meal so that they can make an informed choice whilst seated at the table. For people with dementia this good practice supports their decision-making and communication skills. The tables are well presented with linen tablecloths, condiments, napkins and (where residents’ capabilities allow) teapots. In these ways, residents are encouraged to help themselves to condiments and drinks. Newer residents described how the cook came to see them when they first moved in to find out their likes and dislikes, and to discuss possible menu choices with them. Another resident described how the cook comes to see them every day to see what they fancy because they are on a special diet. It is Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 16 very good practice that the cooks spend time with residents, listening to their suggestions and views. One person said, “The food is lovely – and so are the cooks!” A resident said, “It’s always very good. We are very lucky to have excellent cooks. They get you anything you want or fancy.” Another resident said, “It’s excellent. We are so well-fed that we’re putting on weight. ” Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. Good complaints and protection systems are in place and dealt with effectively so that residents’ rights are safeguarded. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The people who live here have good information about how to make a complaint in their welcome packs. There is also information in the hallway next to the visitors’ signing-in book about how to raise concerns or complaints. Since the last inspection the complaints procedure has also been voiced onto cassette tape. This means that it can be listened to by any future residents who may have a visual impairment or reading difficulty so that they have the same information as everyone else. In surveys the majority of residents and relatives said that they knew who to talk to if they were unhappy with the service. All the residents who took part in discussions at this visit said that they would go straight to the manager, and were very confident that she would take the right action. One relative said, Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 18 “The manager and staff are very approachable. They are always there to listen.” There have been two concerns since the last inspection, both about a staff who no longer works at the home. These concerns were investigated and acted on immediately. During discussions with the manager it was clear that she was fully aware of her responsibilities to protect the people who live here within safeguarding adults processes. It was evident that she had taken the correct action during a recent concern. Staff have had, or are nominated for, training in the local Safeguarding Adults procedures. This means they know how to report any allegations of abuse. A copy of the home’s reporting procedures is in the staff room to remind staff of their responsibility and duty of care to report bad practices. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 25 and 26. People who use the service experience good quality outcomes in this area. Overall the standard of decoration and furnishing in the home continues to improve so that residents enjoy good quality accommodation. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Overall the building is in a good state of repair and well maintained. The home benefits from having a full-time maintenance staff to attend to minor repairs and redecoration. The home provides 32 single rooms, all with en-suite facilities. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 20 Over the past couple of years there have been continuous improvements to the accommodation at Appletree Grange. Since the last inspection dining rooms and lounges have been enlarged and redecorated. More bedrooms have been redecorated and refurbished. The lighting to the corridors has been improved so it is much brighter for the people who live here. The kitchen now has a rear door so that catering deliveries can be received without having to go through the main corridors. A sheltered patio area has been made at the front of the house, and residents said that they had enjoyed “popping out for some sunshine” in better weather. The home has also used a grant from the local council to provide colourcontrasted doors and handrails. The doors to all bathrooms, toilets and ensuites are now painted pale blue so that residents can easily recognise these doors. All handrails have also been painted this colour so that they are easier for people to see, and help people find their way to bathrooms. There are also plans for further improvements in the near future. The front entrance is going to be fitted with electronic double doors to allow much easier access for people who use a wheelchair. At this time the homes bathrooms are functional and reasonably equipped but are now quite worn. However the manager confirmed that bathrooms are to be upgraded and fitted with new lifting equipment as part of the future programme of refurbishment in the new year. The bedrooms examined were comfortable, warm and well furnished. Many have been highly personalised by residents and their relatives. Staff have helped some residents to make a ‘memory box’ (a small box with small artefacts and photographs that they can relate to) outside their bedroom door. This helps to remind them which is their bedroom. The living areas of the home also have a good standard of decoration and furnishings. Lounges are comfortable, warm, bright and cheerful. Residents and their relatives described the home as “very good accommodation”, “very homely”, and “warm and comfortable.” The sample of areas of the home that were examined were very clean and odour control is very good. Residents commented, “the home is very clean”, and “my bedroom is cleaned very day.” All staff have had training in infection control. There are dedicated laundry staff, and a well–equipped laundry area. Residents and their relatives commented positively on the laundry service. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. The home provides sufficient, competent, well-trained staff to ensure that the needs of the people who live here are met. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The home aims to provide four care staff through the day and evening (e.g. 8am-10pm), providing at least one senior carer, and three care staff. There are three staff (including a senior carer) on waking duty through the night. The home also employs sufficient domestic, laundry and catering staff. The home also has a part-time administrator (who manages administrative and financial matters), a maintenance staff and an activities co-ordinator. The home’s compact layout allows for good staff presence in lounges. Most residents felt that staff are on-hand to assist when they are needed. Some residents commented, “Staff are around all the time”, “staff are always there when I need them” and “staff are always available.” Four of the twelve Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 22 relatives who sent in surveys felt that more staff would be helpful for some one-to-one activities. It was clear from observations and discussions with residents that they enjoy a good relationship with staff. Residents said, “all the staff are nice” and “some staff are like family to me”. Staff wear small name badges that could be difficult for residents to see. Some newer residents suggested that it would be good to have photographs of the staff and their names to help them remember who is who when they first move in. The manager felt that this was a good idea and intends to have a photo-board of all staff for residents and their visitors to view. Barchester Healthcare is an equal opportunities employer and promotes clear equality and diversity procedures when recruiting new staff. There is a mix of age, gender, and experience amongst the staff group. There have been 6 changes to the staff team since the last inspection, and there are currently three night staff vacancies. However most staff have worked at the home for many years and this provides residents with good continuity of care. Staff records showed that, in most cases, all checks and clearance had been taken up before new staff started to work here. However in a couple of cases new staff had started work whilst waiting for their CRB (criminal records bureau) clearance. This had occurred during a period of several staff changes and before the new manager was in post. The new manager is clear that staff would not start work without all clearances being in place. It was clear from training records and from discussions with the manager and staff that Barchester Healthcare provides very good training opportunities. Individual training and development records clearly show the courses that each member of staff has completed. A computerised training events programme also highlights when training certificates will expire so that further training can be arranged in a timely way. All new staff receive in-depth induction training (that complies with Skills for Care Council standards), and have support to go onto further training in care. It is very good practice that all care staff (except one new staff) have achieved either NVQ level 2 or 3, which are care qualifications. It is also good practice that catering and domestic staff have opportunities to train towards NVQ qualifications in their areas of work. Around 8 care staff have had training in ‘Positive Dementia Care’, which supports them in their care of people with dementia care needs who live here. A rolling programme of this training will ensure that all care staff have the chance to do this. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience good quality outcomes in this area. The home is well-run in a way that upholds the best interests of the people who live here, and ensures their health, safety and welfare are protected. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Since the last inspection the previous manager has retired after many years service at this home. The former deputy manager has been appointed as the Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 24 new manager. These planned management changes have ensured good continuity in the running of this home. The new manager has worked at Appletree Grange for 21 years and was the deputy manager for 6 years. She has achieved NVQ level 4 in Care and the Registered Managers’ Award, which are suitable qualifications for managing a care home. She is applying to be registered with CSCI. In discussions residents, relatives and staff commented positively on the new manager’s appointment and felt that this will help the home to continue its good standard of service. There are clear lines of accountability within the home and within the organisation. The manager stated that Barchester Healthcare provides good support for the running of the home. The manager is supervised by a Regional Operations Director who also visits the home at least once a month and reports back to the organisation on the findings. There are monthly visits by a Clinical Development Nurse, who also carries out audits of the home’s operations. Barchester Healthcare’s comprehensive quality assurance system also includes a number of audits of the service by external consultants, for example health and safety, and catering audits. Residents’ views of the service are sought during the Provider’s monthly visits, as well as via 6-monthly questionnaires. The home holds occasional Residents’ Meetings for residents to give their comments and suggestions that can influence the service. Some residents and/or their relatives continue to manage their own financial affairs and this is encouraged by the home. The homes administrator does support around 13 residents with the safe storage of their personal monies, at their choice. There are clear, accountable, records of any transactions carried out on behalf of each resident (e.g. for hairdressing). These include numbered receipts and two staff signatures. Staff receive training in statutory health & safety matters so that they know how to support residents in a safe way. It is good practice that two staff are moving & assisting trainers so that they can provide all staff with refresher training in this area of care at any time. All catering and care staff (and some domestic staff) have training in food hygiene. There are sufficient staff trained in first aid to ensure that there is always an appointed first aider on duty. In-house fire instruction records showed that some night staff have not always had instruction at the required 3 monthly intervals. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 25 The maintenance staff carries out regular health & safety checks to the building and to equipment used by the people who live here. There are also clear records of the maintenance and servicing of equipment (for example, the lift and bath hoists) by external services. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X 3 3 X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Timescale for action 01/02/08 2. OP29 19(5) 3. OP38 23(4)(d) The medication cupboard must be fit for purpose; and the medication trolley must be kept locked when no staff are present. This is to ensure that residents’ medication is kept secure at all times. 01/01/08 All new staff must have a Criminal Records Bureau check before starting work. The commencement of new staff with only a POVAFirst check must be in ‘exceptional circumstances’ and must be first agreed with the CSCI. This is to ensure that only suitable people provide care for the people who live here. Night staff must receive in-house 01/01/08 fire instruction at least every 3 months. This is to ensure that they are fully aware of what to do in the event of a fire. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 2. 3. 4. 5. Refer to Standard OP2 OP7 OP7 OP12 OP21 OP27 Good Practice Recommendations Residents should have information about the range of fees, and which applies to them, on admission to the home. If a resident has specific behavioural needs, there should be guidelines for staff to follow so that they respond in a consistent way. Risk assessments should be reviewed more quickly than the usual 6 months if circumstances change. The home should continue to expand the range of suitable activities for people with dementia care needs. Proposals for bathrooms to be redecorated should continue. Consideration should be given to a photoboard of staff with their names and designation for residents and visitors. Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Appletree Grange DS0000061451.V348142.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!